Neuroplasticity and Traumatic Brain Injury

The perceptual process “begins outside of you, with stimuli in the environment… and ends with the behavioral responses of perceiving, recognizing and taking action” (Goldstein, 2014, p.5). In other words, it is the sequence of psychological steps that a person uses to organize and interpret information from the outside world. The selection, organization, and interpretation of perceptions can vary depending on different people. An example of this can be found when individuals react differently in a situation. Part of one’s behavior can be explained by examining their perceptual process, and how their perceptions are causing a specific reaction. Perceptual selection is determined by external and internal factors and is the process by which individuals filter information. Factors such as personality, motivation, and experience are internal factors that drive one’s perceptual selection. For example, the patterns of associations one has learned in the past can affect their current perception. Going further, an individual will tend to select perceptions in a way that fits with what they have found in the past. Factors such as size, contrast, repetition, and familiarity are external factors that increase selection. After certain perceptions are selected, they can be organized differently. Perceptual organization is the process by which elements in the environment become perceptually grouped (Goldstein, 2014).

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The way an individual thinks and processes information and situations happening in the environment around them, define who that person is. The way in which the brain interprets the world virtually defines one’s temperament. With this understanding, it means that if brain injury occurs, the interpretation and perception of one’s surroundings will be affected. A traumatic brain injury is a non-congenital brain insult from an external force that leads to a temporary or permanent impairment of brain function (Mckee & Daneshvar, 2015). Broadly speaking, traumatic brain injuries consist of physiological changes in brain function typically due to external forces. A traumatic brain injury may occur in different ways such as; falls, athletic injury and car accidents. Going further, these injuries may result in cell death, gliotic scar formation, or damage from inflammation (Laskowitz & Grant, 2016). In their handbook, Mckee and Daneshvar (2015) research the neuropathology of traumatic brain injuries and have divided them into three grades of severity: mild, moderate and severe. In their research, the two authors emphasize the harsh reality that most brain injuries result in persistent, long term debilitating effects. Associations between traumatic brain injuries and neuropsychiatric disorders have been acknowledged for many years (Tateno, Jorge, & Robinson, 2003). One of the most socially and vocationally disruptive consequences of these neuropsychiatric disorders is aggressive behavior (Tateno, Jorge, & Robinson, 2003). In a clinical study, these authors assessed the aggressive behavior found in eighty-nine patients with traumatic brain injury and twenty-six patients with multiple trauma but without the official diagnosis of a traumatic brain injury. Using a quantitative scale, researchers examined the clinical correlates. The findings of their study concluded aggressive behavior found in 33.7% of traumatic brain injury patients and 11.5% of patients without a traumatic brain injury (Tateno, Jorge, & Robinson, 2003). Going further, they also found that the patient’s aggressive behavior was greatly associated with depression, frontal lobe lesions, and poor social functioning (Tateno, Jorge, & Robinson, 2003). In summary, aggression following traumatic brain injury is associated with multiple psychosocial factors and impaired social function (Tateno, Jorge, & Robinson, 2003).

Pathological mental fatigue after mild traumatic brain injury is characterized by mental fatigue following any sort of cognitive activity (Skau, Bunkertorp-Kall, Kuhn, & Johansson, 2019). Researchers conducted a study to investigate how prolonged mental activity affects cognitive performance in patients with mild traumatic brain injuries. Long-lasting mental fatigue interferes with an individual’s daily routine, the ability to work and has a negative impact over one’s mental health and well being. Pathological mental fatigue can be defined as mental exhaustion during sensory stimulation or long periods of cognitive activity (Skau et al., 2019). Mental fatigue is suggested to be related to the circuits that mediate motivation, learning, goal-directed behavior and emotion regulation (Skau et al., 2019). In a block of six neuropsychological tests, researchers set out to study how prolonged mental activity affects cognitive performance in individuals with mental fatigue after traumatic brain injury. As the study concluded, researchers found indications that individuals with mental fatigue following brain injury have reduced the efficiency of neuronal activity in the frontal cortex (Skau et al., 2019). Additionally, researchers suggested a deterioration of cognitive function in the patients studied (Skau et al., 2019).

Traumatic brain injury can result from either external or internal forces, though the most common source is by blunt force trauma, stroke, or alcohol/substance misuse. Going further, injuries may cause direct damage to neurons and blood vessels, as well as indirect damage resulting from secondary ischemia, edema, or inflammation (Su, 2016). Whatever the cause may be, when the brain experiences injury, new neutrons will travel around the damaged area and form a new communication connection (Laskowitz & Grant, 2016). Many neuroscientists, such as Marc Lewis, argue the brain’s capacity to be reformed and withstand the occurrence of trauma. In an article that studies the way in which the brain changes in addiction, Lewis (2017) describes the fundamental role of the human brain to develop through experience, adapting to trauma and adversity. He goes on further to note that the stages of development and learning throughout adulthood are all underpinned by changes in the cortex and limbic regions, yet the loss of cortical control is thought to be long-lasting, even permanent. However, synaptic pruning and neuronal regeneration is a normal developmental process (Lewis, 2017). This process of neuronal regeneration is known as neuroplasticity, the occurrence of new neurons being generated in the brain to form stronger bonds (Lewis, 2017). To put it simply, this is the brain’s ability to allow tissues to grow, adapt, and change.

Until recently, scientists believed that brain development was formed and rigid by the time we reached adulthood. Now, however, researchers recognize that our brains are constantly changing throughout our lives. Going further, research has suggested that neuronal plasticity occurs after an injury in three phases. Immediately after the happening of an injury, cell death occurs along with a decrease in cortical inhibitory pathways (Su, 2016). Eventually, these pathways that are thought to recruit secondary neuronal networks, shift from inhibitory to excitatory followed by neuronal proliferation and synaptogenesis (Su, 2016). From there, cells such as endothelial progenitors, glial cells and inflammatory cells are recruited to replace the damaged cells (Su, 2016). In the weeks following the injury, new synaptic markers are created allowing for the remodeling and cortical changes to occur, aiding in recovery (Su, 2016).

Advancements in technology and modern research are coming closer every day to understanding the exact mechanisms of such neurophysiology phenomenon. Researchers discovered that both radial glia in neonates and radial glia-derived cells in the adult lateral ventricular wall generated self-renewing neurospheres (Merkle, 2004). In other words, their study demonstrated that radial glial cells serve as early progenitors for neurons soon after birth as well as they give rise to adult subventricular zone stem cells that continue to produce new neurons throughout adult life (Merkle, 2014). It is important to note that while traumatic brain injuries are inherently debilitating, accommodations and interventions are put in place to mitigate the impact. Researchers studied interventions that drive neuroplasticity in a positive direction and have the potential to improve general health.

There is promising evidence that reveals to researchers that the powerful components and qualities of the brain do play a vital role in how much a patient can recover from trauma. The option for therapeutic opportunities is being explored such as gene expression and cellular proliferation (Lewis, 2017). Additional therapies involving positive or humanistic approaches such as meditation and mindfulness, as well as music therapy prove to be another avenue of treatment. Of course, there is also the option of medical treatment. Nadia Webb (2015) discusses the intervention tools offered by pharmacotherapy. She explains that mindfulness practices, such as meditation, and pharmacotherapy can be used to improve executive functioning and emotional self -regulation after a traumatic brain injury. However, it requires a great deal of motivation, discipline and active participation by the patient in order for the psychotherapy to be successful.

Nutrition and supplementation have also been a proven viable treatment option for the secondary effects of traumatic brain injury (Lucke-Wol  et al., 2018). Nutritional and supplementation targets may reduce the chances of inflammation and neuronal cell death (Lucke-Wold et al., 2018). Commonly used dietary supplements for traumatic brain injury include vitamins and minerals such as Zinc. Not only has it been proven to reduce stress, but zinc has also been shown to reduce inflammation and apoptosis in pre-clinical models of brain injury (Lucke-Wold et al., 2018). Researchers continued on to claim that the introduction of zinc in the diets of patients may help to preserve brain tissue (Lucke-Wold et al., 2018).

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In addition to nutrition and supplements, alternative therapies such as acupuncture, acupressure, mind-body practices, and musical therapies can also be prescribed to patients recovering from a brain injury. Acupuncture involves pricking with skin with fine needles, with the ultimate goal of alleviating pain. A study was conducted to review the safety and effectiveness of acupuncture on a patients rehabilitation phase. The study found that patient who participated in acupuncture treatment were found to require less medical care within the first year of the brain injury (Lucke-Wold et al., 2018). The study continued and found that the acupuncture treatment had beneficial effects of the patients sleep quality (Lucke-Wold et al., 2018).

Following a traumatic brain injury, it is possible for damage to the orbitofrontal cortex to occur. The orbitofrontal cortex is located in the secondary olfactory area and when damaged, can lead to complex behavioral changes, such as difficulty with attention and concentration (Vik, 2019). A study was conducted to investigate the effects of musical training on patients with behavioral and cognitive deficiencies following a traumatic brain injury. Musical therapy is an intervention that allows the participant to address their emotional, physical and spiritual needs. This type of intervention can be seen in many ways such as: creating, improving, playing or listening. Music therapy treatment looks like selecting from a range of music-based interventions and using both music and the therapist-patient relationship as agents of change (Lucke-Wold et al., 2018). To test this theory, participants were asked to participate in two piano sessions each week, for a total of eight weeks (Vik, 2019). Each session was thirty minutes long and participants were required to complete a minimum of fifteen minutes on their own at home. Three groups participated in this study: one group which consisted of patients recovering from traumatic brain injury and two groups consisting of healthy participants, one with musical training and one without. taking place two years post-injury, all participants were assessed with neuropsychological tests both pre and post-intervention (Vik, 2019). As the study concluded, researchers discussed the evidence on how music activity truly activates the brain (Vik, 2019). Upon completion of the intervention, participants were seen to have increased functional neuroplasticity predominantly in the orbitofrontal cortex (Vik, 2019). Researchers went on further to discuss how music activity also activates areas involved in episodic and semantic memory (Vik, 2019). Additionally, participating in musical activity stimulates and strengthens perception and cognition (Vik, 2019). Researchers ended this study with the conclusion that repetition, evident in musical patterns, contribute to strengthening new neural connections through neuroplastic changes (Vik, 2019).

Researcher and psychologist, Joyce Shaffer (2016) also agrees with musical intervention in hopes to mitigate the impact of a traumatic brain injury. Her ultimate goal was to provide an overview of ways in which neuroscience can reveal treatment protocols to empower patients to make the lifestyle choices that can increase brain power. In her review, Shaffer (2016) studies ways in which to motivate individuals to make healthy lifestyle changes that enhance vigorous longevity, health, happiness, and overall wellness. One of the interventions included in her study is the enrichment of music. As it requires integration of audiovisual information, researchers recognize music as a complex and multi-sensory form of enrichment that has a positive influence on neuroplasticity (Shaffer, 2016). Whether it is sight-reading music, lyrics or playing a musical instrument, musical activity is complex and comprises motor, auditory and visual sensory integration. Because of its ability to greatly impact one’s emotional state as well as motivation level, musical training has become a common framework to study brain plasticity (Seinfeld, Figueroa, Ortiz-Gil, & Sanchez-Vives, 2013).

To conclude, it is crucial to study and understand the concepts of perception as it extends beyond useful application. When studying this concept, it can assist one in becoming more aware of the nature of their own personal experience and those around them. The way an individual thinks and processes information and situations happening in the environment around them, define who that person is. The way in which the brain interprets the world virtually defines one’s temperament. With this understanding, it means that if brain injury occurs, the interpretation and perception of one’s surroundings will be affected. Although the effects and symptoms that result from experiencing a traumatic brain injury can be inherently debilitating, accommodations and interventions are put in place to mitigate the impact. Whether it is through prescribed medication, natural remedies, or musical therapy, the possibilities to mitigate the impact of a traumatic brain injury through neuroplasticity are endless. Numerous researchers have come together and studies have been conducted to prove the complexity and beauty of the brain and mechanisms responsible for perceptual experiences. Going further, they have studied interventions that drive neuroplasticity in a positive direction and have the potential to improve general health and well-being.

CITATIONS

• textbook – goldstein
• Mckee, A. C., & Daneshvar, D. H. (2015). The neuropathology of traumatic brain injury. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25702209
• Tateno, A., Jorge, R. E., & Robinson, R. G. (2003). Clinical correlates of aggressive behavior after traumatic brain injury. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12724455
• Webb, & Nadia. (2015). Pharmacotherapy for pediatric traumatic brain injury.
• Skau, S., Bunketorp-Käll, L., Kuhn, H. G., & Johansson, B. (2019, May 14). Mental Fatigue and Functional Near-Infrared Spectroscopy (fNIRS) – Based Assessment of Cognitive Performance After Mild Traumatic Brain Injury. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527600/
• Laskowitz, D., & Grant, G. (Eds.). (2016). Translational Research in Traumatic Brain Injury. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26583170
• Su, Y. S. (2016). Neuroplasticity after Traumatic Brain Injury. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK326735/#ch8_sec1
• Lewis, M. (2017). Addiction and the Brain: Development, Not Disease. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486526/
• Merkle, F. T., Tramontin, A. D., García-Verdugo, J. M., & Alvarez-Buylla, A. (2004). Radial glia give rise to adult neural stem cells in the subventricular zone. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC536036/
• Shaffer, J. (2016). Neuroplasticity and Clinical Practice: Building Brain Power for Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960264/
• Vik, B. M., Skeie, G. O., & Specht, K. (2019). Neuroplastic Effects in Patients With Traumatic Brain Injury After Music-Supported Therapy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604902/
• Seinfeld, S., Figueroa, H., Ortiz-Gil, J., & Sanchez-Vives, M. V. (2013, November 01). Effects of music learning and piano practice on cognitive function, mood and quality of life in older adults. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3814522/
• Lucke-Wold, B. P., Logsdon, A. F., Nguyen, L., Eltanahay, A., Turner, R. C., Bonasso, P., . . . Rosen, C. L. (2018). Supplements, nutrition, and alternative therapies for the treatment of traumatic brain injury. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491366/